Case Report

The decedent was a 32-year-old man with a history of obsessive-compulsive disorder, trichotillomania, and misuse of cannabis and magic mushrooms, but no history of suicidal ideation or attempts. He had reportedly advised his girlfriend of his intent to use magic mushrooms alone while she was away on vacation. After missing a phone call, a friend was sent to confirm his well-being at the behest of his girlfriend. The friend observed the decedent hanging from the stairs in his secure apartment and called the police. Upon their arrival, the doors to the residence were locked. The first floor of the house was in disarray with overturned furniture and broken dishes on the floor. Magic mushroom packages were in the kitchen and marijuana was in the pantry. There was abundant blood staining in the upstairs bathroom with a blood-stained knife on the counter. The toilet was filled with an opaque liquid. An empty bottle of liqueur, a container of bleach, and a container of orange juice were on the bathroom floor. The dressed body was suspended over the stairs from the banister, a few centimeters above a step, by an electrical extension cord around the neck as a cervical ligature. A black plastic garbage bag was over the decedent's head, with the mouth of the bag occluded by the electrical cord ligature that was around the decedent's neck on the outside of the bag. The items of clothing worn consisted of a winter jacket and a bloodstained white towel around the hips. Multiple incised wounds of the anterior aspects of both forearms were evident. The electrical cord ligature was focally bloodstained (Figures 1 to 3).

Figure 1.: The body suspended from the rungs of the banister by an electrical extension cord, with the mouth of a plastic bag occluded by the electrical cord ligature around the decedent's neck.

Figure 2.: Magic mushroom on the scene.

Figure 3.: Disarray of the first floor with broken dishes.

Postmortem examination yielded the body of a slightly overweight young adult man with gravitationally dependent hypostasis within the lower limbs, consistent with the body position when found. There was no congestion or cyanosis of the face, and the eyes were devoid of petechiae. The tip of the tongue was externally protuberant. A torn black plastic garbage bag was over the head. The plastic bag had been torn open on scene by the police to facilitate visual confirmation of identity. The neck exhibited an upwardly slanted, posteriorly incomplete, ligature mark of 1.2 cm width that was consistent with having been caused by the cylindrical electrical cord which had been fashioned into the cervical noose ligature which had been around the neck. Layered dissection of the anterior neck in a bloodless field revealed a fracture of the left superior horn of the thyroid cartilage and bilateral fractures of the greater cornua of the hyoid bone, without contusion of the anterior cervical muscles (Figures 4 to 6).

Figure 4.: Protuberance of the tongue.

Figure 5.: Upwardly slanted and posteriorly incomplete ligature mark. Multiple, superficial, parallel, linear incised wounds of the neck.

Figure 6.: Layered dissection of the anterior neck without contusion of the anterior cervical muscles.

There were multiple, superficial, parallel, linear incised wounds of the left and right sides of the neck and across the front of the left and right forearms. The incised wounds of the neck had not injured the common carotid arteries, jugular veins, or vagus nerves.

Interspersed among the multiple superficial incised wounds across the forearms were three deeper, linear incised wounds of the left forearm of 6.5, 5, and 3.8 cm and a 5 cm × 1 cm gaping incised wound across the front of the right wrist. Solitary, superficial incised wounds were present on the abdomen, front of the right thigh, left hip, and palmar aspects of both hands. Several discrete small abrasions were also noted (Figure 7).

Figure 7.: (A) A wide, gaping incised wound across the front of the right wrist. (B) Three deep, linear incised wounds on the left forearm.

Examination of the major organs was unremarkable. There was no gross or microscopic natural disease that contributed to death. Standard biochemical analysis of the vitreous humor was unremarkable.

Toxicological analysis of the femoral venous blood and urine by a forensic toxicology laboratory reported unquantified detection of psilocin and acetaminophen in the urine as the only positive findings. That laboratory did not possess an analytical method to quantify psilocybin. Attempted analysis of the femoral venous blood by a second forensic toxicology laboratory for psilocybin was unable to produce a result due to analytical issues with the referred sample.